Is it possible to ablate typical atrial flutter using pulsed field energy quickly, effectively and safely? Real-world experience with the CENTAURI PEF system

Abstract Introduction Catheter ablation of the cavotricuspid isthmus (CTI) during ablation of the typical atrial flutter is the method of choice in the treatment of this arrhythmia. Pulsed field energy (PFA) appears to be an effective alternative to radiofrequency energy, however, data on the safety of this method are contradictory. The use of PFA is burdened by specific complications, such as coronary artery spasm with ST elevations or atrio-ventricular (AV) conduction disturbances. The aim of our work is to analyze the acute efficacy and safety of the procedure in patients undergoing PFA CTI using the Centauri PEF system. Methods Retrospective analysis of a consecutive group of patients undergoing PFA CTI as part of the primoablation or redo ablation of the complex atrial arrhythmias using EnSite Precision 3D mapping system, Tacticath CF ablation catheter and Centauri PEF PFA generator. Periprocedural parameters, efficacy and safety were statistically assesed. The length of the ablation line was measured using a special automatic algorithm. Results A total of 117 patients were enrolled to the study between 7th January 2025 and 31th December 2025. Almost all patients undergoing PFA CTI during ablation of the complex atrial arrhythmias. The basic diagnosis was atrial fibrillation primoablation in 41,9%, atypical atrial flutter ablation in 6%, typical atrial flutter ablation in 2,6% and atrial fibrillation redo procedure in 49,5%. Basic parameters of the patient group was typical for patients undergoing catheter ablation of complex atrial arrhythmias: 29% were women, the average age was 63 years and the mean left atrial size was 45 mm. Bidirectional CTI block was achieved in 100% of patients. The average total procedure time was 142.4 ± 71.5 min., the average X-ray dose was 3332 ± 3211 mGy/cm2. The average duration of the CTI ablation was 7.0 ± 5.9 min., the average length of the ablation line was 44.4 ± 19.5 mm with an average number of 17.6 ± 13.4 ablation points. First-pass block was achieved in 91% of cases and reconduction in 9% of patients. No severe conduction disturbances occurred, only 7.7% of patients had prolongation of PR interval more than 20msec. (max 52 msec), but average change of PR interval was -1 ± 19 msec. One case (0.8%) of coronary artery vasospasm with ST elevations promptly resolving after nitrate administration was reported. One case (0.8%) of the cardiac tamponade was recorded and groin complication occurred in two patient (1.6%), no stroke, atrioesopfageal fistula or death occured. Conclusion Catheter ablation of the cavotricuspid isthmus using focal PFA with the Centauri PEF system is a safe and highly effective method in the treatment of typical atrial flutter. Cardiac tamponade did not occur in connection with PFA CTI, but with a basic, complex procedure in the left atrium. The percentage of complications is lower compared to published data.